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P I E R C E C O L L E G E A S S O C I A T E D E G R E E I N

N U R S I N G

A D N P R O G R A M A P P L I C A T I O N P A C K E T

P R O G R A M S T A R T S W I N T E R . 2 0 1 5

Ap p l i c a t i o n D u e D a t e i s M o n d a y , J U L Y 7 , 2 0 1 4

5 : 0 0 p m

( U p d a t e d 4 / 2 5 / 1 4 )

The Pierce

College Puyallup Associate Degree Nursing Program’s mission is to provide students

with a comprehensive, quality education based upon current professional practice and incorporating

respect of the individual, to meet the diverse needs of our community.

WORKSHOP FOR ADN WINTER 2015 APPLICANTS

Application Workshop: Fri. June 6, 2:00 – 4:00pm Room AAH 130

Arts and Allied Health Building

(This is a complimentary workshop and attendance and sign-up is not required.)

___________________________________________________________________

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SECTION

ONE



Letter from the Director



Program Introduction



Program Contact Information

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LETTER FROM THE DIRECTOR

Greetings!

It is my pleasure to welcome you to Pierce College. The application process for the Pierce

College Nursing Program is challenging yet rewarding. Our aim is to ensure that all individuals

have an equal opportunity to “shine” during this process; we support prospective students in their

endeavor toward achieving the next step in the academic journey toward becoming a professional

registered nurse and obtaining an Associate Degree in Nursing.

You will find that the Pierce College Nursing Program is outstanding and distinctive. We are

built on a foundation of respect for all individuals in our community. We strive for inclusion of all

from our diverse community by training qualified registered nurses and developing each student’s

unique abilities. Our commitment to quality nursing education and teaching excellence prepares

learners to live and work successfully as registered nurses in an ever-changing healthcare

environment in this new millennium.

I urge you to take advantage of the rich resources that are available to you at Pierce College

during this application process. Nursing is a rewarding career choice, and our application and

selection process are rigorous. We will ask many questions to assess your academic qualifications.

Remember, the faculty and staff of the Pierce College Nursing Program support you in this

endeavor and we encourage you to ask questions throughout the process.

Good luck!

Warmest Regards,

Becky Piper, M.N., R.N.

Nursing Director, Associate Professor

Pierce College Puyallup Allied Health

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PROGRAM INTRODUCTION

Pierce College offers the Associate Degree in Nursing for students who wish to become Registered Nurses. This program begins with a strong foundation in basic nursing skills, from which students then advance to more complex nursing concepts. A solid base in the natural and social sciences is included to provide students with a greater understanding of patient care in a variety of settings. During the course of the program, students receive experience in acute care, maternal/child, acute care specialties, community and mental health settings.

Graduates will earn an Associate Degree in Nursing from Pierce College, then must take and pass the NCLEX-RN examination in order to be licensed as Registered Nurses in their state of residence. Licensed graduates qualify to be employed as entry-level nurses in hospitals, long-term care facilities, rehabilitation centers, clinics, health care providers’ offices, and home care agencies. They are also able to plan and coordinate patient care. In addition, Pierce College ADN graduates have the option of enrolling in the BSN Completion program at UW-Tacoma or St. Martin’s University.

The Pierce College Puyallup Nursing Program seeks students who are committed to the profession of nursing. Before applying to our program, applicants should explore all facets of a nursing career, which may include, but not be limited to: infection control, practice settings, and the law as it pertains to nursing practice.

Our program is distinctive. We are built on a foundation of respect and openness to change. We strive to meet the needs of our diverse community by training qualified registered nurses and developing each student’s abilities. Our commitment to quality nursing education and teaching excellence prepares learners to live and work successfully as registered nurses in an ever-changing healthcare environment.

Please read the enclosed information carefully and follow the application procedures

exactly.

EACH APPLICANT MUST MEET ALL DEADLINES AND SPECIFIC REQUIREMENTS IN ORDER TO BE CONSIDERED A QUALIFIED APPLICANT TO THE PIERCE COLLEGE ASSOCIATE DEGREE IN NURSING PROGRAM. THERE WILL BE NO EXCEPTIONS MADE.

Send Completed Application Packet To:

Pierce College Puyallup Associate Degree in Nursing Program ATTN: Stania Kasjan/Nursing

Pierce College Puyallup 1601 39th_{Ave. SE}

Puyallup, WA 98374-2222

Pierce College District does not discriminate on the basis of race, color, national origin, sex, sexual orientation, disability, or age in their programs and activities.

Admission to the Pierce College Associate Degree in Nursing Program is competitive. Completion of prerequisite coursework and this application does NOT guarantee admission into the program.

The Pierce College Associate Degree in Nursing program forms a community of learners committed to the discipline of nursing. Our specialized community is built on a foundation of respect and an openness to change. Together we strive to meet the needs of our diverse community for qualified

registered nurses and develop each nursing student’s abilities in nursing. Our commitment to quality nursing education and teaching excellence prepares learners to live and work successfully as registered nurses in an ever-changing health-care en

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PROGRAM CONTACT INFORMATION

Nursing Program Office / Staff

Full Time Nursing Faculty

Pierce College Nursing / Allied Health

Becky Piper, M.N., R.N.

1601 – 39

th

Avenue SE

Puyallup, WA 98374

Ronda Durano, R.N., M.N.

(253) 864-3272

www.pierce.ctc.edu

Elizabeth Webber, RN, MSN, CCRN

Leah Webster

Program Coordinator

Nursing Front Office Assistant

(253) 864-3272

lwebster@pierce.ctc.edu

Becky Piper, M.N.,R.N.

Other Pierce College Support Offices

Nursing Program Director

Pierce College–Puyallup-Financial Aid

(253) 864-3111

(253) 840-8398

bpiper@pierce.ctc.edu

Federal School Code: 005000

Eustenia (Stania) Kasjan, M.A.

Pierce College-Puyallup Testing Center

Allied Health Program Manager

(253) 840-8343

Pre-Nursing Advising/Admissions

(253) 840-8355

Pierce College – Puyallup Access

ekasjan@pierce.ctc.edu

Disability Services

(253) 840-8335

Leslie Watts

Faculty and On Call Advisor

Ft. Steilacoom

lwatts@pierce.ctc.edu

Mike Peluso

General Advising/Faculty

Pre-Nursing Advising (On Call)

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SECTION TWO



Nursing Prerequisite Requirements

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NURSING PREREQUISITE REQUIREMENTS

Please see the Course Equivalency Chart at the back of this packet for course transferability from other Washington State

schools. For credits earned outside Washington State or courses not listed on the Course Equivalency Chart, please contact

the nursing program office to obtain the proper waivers

prior to

submitting your application to the nursing program.

MINIMUM QUALIFICATIONS

ENGL& 101 -

COMPOSITION – EXPOSITION

BIOL& 241

-

ANATOMY & PHYSIOLOGY I / LAB

BIOL& 242

-

ANATOMY & PHYSIOLOGY II / LAB

BIOL& 260

-

MICROBIOLOGY

CHEM& 121 -

INTRO TO CHEMISTRY (Inorganic)

PSYCH&200 - HUMAN LIFESPAN DEVELOPMENT

- MINIMUM QUALIFICATIONS MUST BE SUCCESSFULLY COMPLETED BY END OF AUGUST 2014 - APPLICANTS MUST EARN A 3.0 (B) OR BETTER IN EACH COURSE

- ALL COURSES MUST HAVE BEEN TAKEN WITHIN THE LAST 7 YEARS OF APPLICATION DATE

Eng. & Psych Course may be more than 7 years old if part of a degree.

TRANSFER-READY COURSE WORK FOR ADDITIONAL 4 POINTS

TRANSFER-READY APPLICANTS MUST HAVE ALL OF THE ABOVE COURSES, INCLUDING THE FOLLOWING:

MATH& 146 -

INTRO TO STATISTICS

= 2 POINTS

WORLD LANGUAGES –

10 COLLEGE CREDITS, OR 2 YEARS HIGH SCHOOL (of same language), or native speaker* = 2 POINTS

*Must meet native speaker requirements (see advisor for details)

- GRADES MUST BE NO LOWER THAN A 2.0 (C)

- STATISTICS COURSE MUST HAVE BEEN TAKEN WITHIN THE LAST 7 YEARS OF APPLICATION DATE

RECOMMENDED COURSEWORK

(WILL ADD 1 EXTRA POINT)

CHEM& 131 -

INTRO TO ORGANIC AND BIOCHEMISTRY

= 1 POINT

- GRADE MUST BE NO LOWER THAN A 2.0 (C)

- CHEM COURSE MUST HAVE BEEN TAKEN WITHIN THE LAST 7 YEARS OF APPLICATION DATE.

IMPORTANT NOTES ON ALL PREREQUISITE REQUIREMENTS:

 Only the grades in these required courses or their equivalents will be considered in the qualifying phase.

 Successful completion of the required prerequisites does NOT guarantee admission to the Nursing Program.



Only ONE repeat of EACH required prerequisite course will be accepted within the past 7 years and a “W” - withdrawal counts as one take.

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Previous Degrees

For students with previously earned Certificates, Associate or Bachelor degrees, the seven (7)-year limit for non-science

prerequisite courses may be waived for credits earned within that degree. Only the Nursing Program Director or

Pre-Nursing Advisors at Pierce College Puyallup may consider exceptions to this requirement, and it is the responsibility of

the applicant to obtain a waiver prior to the application deadline (Pre-Nursing Advisor will prepare the form). This

waiver will then be added to the Course Prerequisite Listing Form in the application packet after submission.

Other Programs and BSN Completion

Requirements for other nursing and BSN completion programs in the area may be different. If you are planning to apply

to other programs in addition to this one, or intend to complete a Bachelor of Science in Nursing, please contact the

nursing program at the two or four-year college you wish to apply to. Because admission into this program is

competitive, we encourage all of our applicants to prepare to apply to other nursing programs as well.

Course Equivalence of Prerequisite Courses from Other Colleges

All applicants must completely fill out and submit the Course Prerequisite Listing Form (as part of the application

process) to the Pierce College Puyallup Nursing Office to be considered in the selection process. When evaluating

transcripts, the Course Prerequisite Listing Form is a necessary tool.

Equivalence of courses taken at colleges in the State of Washington may be determined by referring to the Prerequisite

Course Equivalency Chart. Any course not indicated on the Prerequisite Course Equivalency Chart MUST be

accompanied by a signed Pierce College Nursing Waiver Form, along with a copy of the course description, course

outline, or course syllabus, in order to be eligible for admission consideration. Please see the Pierce College Puyallup

Pre-Nursing & Allied Health Advisor to prepare the form, if applicable.

All required prerequisites/courses must be completed no later than August 2014 to be eligible to apply.

There may be questions regarding course transferability. It is the applicant’s responsibility to ensure that

all prerequisite coursework will transfer to Pierce College. Please contact the Pierce College Puyallup

Pre-Nursing & Allied Health Advisor to obtain the necessary support paperwork

WELL IN

ADVANCE

of the application deadline, as this may take some time.

Any information provided in this packet is subject to change without notice. Please keep abreast of departmental changes by visiting your advisor regularly, attending information sessions and visiting the program website often.

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SECTION THREE

Application Materials



Notes on Scored Requirements



Scoring, Priority Status, Qualification Information and

Timeline



Application Checklist



Program Application



Course Prerequisite Listing Form



Professional Recommendation Form



Personal Recommendation Form



Personal Statement

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NOTES ON SCORED REQUIREMENTS

Recommendations

Two letters of recommendation are required for application. Forms are provided in this application packet and may be

accompanied by additional documentation. Applicants are to submit ONE professional and ONE personal recommendation. It is essential that the applicant carefully choose who will be submitting their recommendations. The following are some

examples of the type of recommendations the Nursing Program is looking for:

Note: We are looking for letters of recommendation that address health care SPECIFICS rather than generalities. Discuss this with your recommenders and ask them to include our “4 C’s” in their comments about you.

Personal: This would include someone who could attest to your personal attributes or soft skills such as compassion, integrity, empathy, etc. Examples include, but are not limited to: long-time co-workers, first-line supervisors, a former

teacher/professor, a professional nurse (RN, MN, ARNP, FNP) who you have known for some length of time. This CANNOT be your best friend, a fellow student, relative, parent, or significant other.

Professional: This would include someone who could attest to your professional characteristics or potential such as reliability, professionalism and conduct. Examples include, but are not limited to: current employer, second-line supervisor, member of the clergy, recent college professor, a professional nurse or physician you have known for some time. This CANNOT be your best friend, a fellow student, landlord, relative, parent, or significant other.

NOTE-CHANGE:

Have these SEALED letters sent to you and then include them in your application packet.

Functional Resume (Keep as close to 1 page as possible) (Not the employer based/chronological one we all have)

A functional resume enables you to highlight the skills and accomplishments as well as work and life experiences that best relate to your job objective (becoming a Registered Nurse). By creating relevant skill headings, you can incorporate all the experiences that have contributed to each listed skill i.e. co-curricular activities, life experience, family, work history, job shadowing, volunteer work, prior schooling, etc. Include our “4 C’s.”

You are encouraged to seek out resources about writing functional resumes online, in our libraries, or in the Job Connections area of the Advising Centers at Fort Steilacoom or Puyallup campuses.

Personal Statement

A Personal Statement is required as part of the application process. Questions to address are outlined in Section Three of this packet. Applicants are encouraged to seek assistance from the Writing Center or an instructor in writing/editing their Personal Statement. The essays should accurately reflect the applicant’s critical, creative, and reflective thinking as well as their writing ability. Personal Statements will be judged on both content and syntax and are weighed quite heavily. Include our 4 C’s. In order to ensure that all applicants have carefully considered all aspects of a Registered Nursing career in today’s health care system, we encourage using as many of the extrinsic motivators as possible. These may include, but are not limited to:

 Employment – any type of job that has allowed you to work with or be exposed to registered nursing in a nursing care environment.

 Volunteering – in a facility that provides the direct delivery of nursing care or gives you the opportunity to assist or work beside RNs.

 Job Shadowing/Observation – in a nursing care environment, observing RN’s or ARNP’s.

 Informational Interviews – of an RN working in an area or specialty you might be interested in. This enables applicants to learn about different types of specialties available to RN’s. Informational interviews are also written up in Vocational Biographies – available in the Library at Puyallup or on the Internet.

 Nursing Research – In order to increase your knowledge about the field of nursing BEFORE you get started, a lot of information is available in professional nursing journals, reference books, websites, databases, etc. Ask one of our reference librarians for a Nursing Career Pathfinder resource sheet. This research is full of information about nursing history, trends, and scope of practice. If quotes from research are incorporated within your personal statement, be sure to give credit to the source. Information on citing is available via the Library link on the Pierce College website –

www.pierce.ctc.edu/Library/stuck/help.html.

Research Question

A research question is required as part of the application process. You will be required to list at least three peer reviewed reference sources. The content of the paper should not exceed two double spaced pages.

Transcripts

NOTE:

It is the applicant’s responsibility to make sure that all sealed, official transcripts are included in your application packet. DO NOT

have them sent to Pierce College in general (either hard copy or electronically) or to me directly in the nursing office. Have them sent to you and then include them in your packet. This is now your responsibility. If coursework is remaining, another official transcript will be required at the end of spring/summer quarter, and again, you are to deliver them directly to me. Thank you.

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SCORING, PRIORITY STATUS and QUALIFICATION INFORMATION

Scoring

The following elements will comprise the scoring of the application:

Required Elements

Personal Recommendation 8 points

Professional Recommendation 8 points

Functional Resume 6 points

Personal Statement 28points

Total Required Elements 50 points Transfer-Ready course work for Additional Points

Math&146 - Intro to Statistics 2 points World Language - 10 college credits, or 2 years high school 2 points (of same language), or native speaker

Total additional points 4 points Recommended Additional Coursework (Optional)

Intro to Organic and Biochemistry (CHEM& 131 or equivalent) 1 point

Total Optional Points 1 point

Determination of Qualification

Applicant has: Applicant is qualified.

 Paid $65 Application Fee

 Sent in a complete application (see Application Checklist)

 Achieved a minimum 3.0 in ENGL& 101, BIOL& 241,

BIOL& 242, BIOL& 260, CHEM& 121and PSYCH 200 (or equivalents)

 Taken the above courses within the last 7 years

 Completed the Research paper and the Kaplan Entrance Exam

 Additional Materials from the Checklist

Application is missing any of the above criteria Applicant is not qualified.

(There will be NO exceptions and reminder phone calls will NOT be made)

Timeline for Selection Process

Applications available on Pierce College Web Site. June 1, 2014 Complete applications due in Pierce College-Puyallup Nursing Office. July 7, 2014 (Applications turned in before deadline will be appreciated)

Applications processed and scored. July 7, 2014 – Sept 4, ,2014 Applicants notified of status and interview invitations sent to those with Est. Sept 11/12, 2014 the highest scores .

Half-Day group interviews conducted. Est. Mid-Oct. 2014 Candidates notified of acceptance to program. Week after Int. -- 2014 Proof of Spring/Summer class completion and grades due (if applicable) End of June &/or August 2014

Program starts January/Winter Qrt. 2015

If there are any changes in the dates I will post notice on the website.

NOTE: Dept hours on campus change during the summer months. Please refer to the following website as you plan your application timetable or follow-up questions. www.pierce.ctc.edu/ephone/departments

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APPLICATION CHECKLIST

Completed application due July 7, 2014 or Before

□

Pierce College Admissions Form

 All nursing program applicants must currently be in the Pierce College system and have a Pierce College Student ID Number. In order to do so, all applicants must complete and submit, or reactivate if you are a former student, a Pierce College Application for Admission. Admissions forms can be obtained on-line at www.pierce.ctc.edu or at any of the Pierce College campuses (Puyallup, Ft Steilacoom, Ft Lewis, McChord) & take about 72 hrs. to process. Nursing Program applications cannot be processed without a Pierce College Student ID number. (I do NOT need a copy of this Admission form)

 As of January 2, 2009, all former students must fill out a new application form to Pierce College, even though they may already have a Student Identification Number.

□

Receipt Indicating Payment of $65 Application Fee from Pierce College-Puyallup Cashier.

 Payment must be paid to Pierce College Puyallup Cashier PRIOR to applying. Receipt indicating payment must be included with the application. Do not send the check to the Nursing Dept. or include the check in your application packet. Pay it directly to the Cashier before applying and include receipt in packet.

 If you are mailing in your application, checks must be mailed separately to: Pierce College Puyallup/Cashier 1601 39th_{Ave. SE Puyallup, WA 98374 (you may request that a copy of your receipt be forwarded to the Nursing Office} -- they just email it to me. NOTE – Cashier’s office may not be open on Fridays during the summer).

 To ensure proper filing, please send payment early, if possible, so that you may follow up with the Nursing Program Office before the application deadline.

□

Pierce College Associate Degree in Nursing Program Application (included in packet)

□

Course Prerequisite Listing Form (included in packet)

 The Nursing Program Advising Office should have an Equivalency Waiver Form with the attached documentation in your file for any classes taken outside of the state of Washington. Please verify with the Nursing Advising Office that this form has been completed prior to submitting your application.

 The applicant is responsible for completing the Course Prerequisite Listing Form included in this packet. Please cross-reference with the Washington State College and University Course Equivalency Chart in this packet.

□

OFFICIAL Transcripts from ALL Colleges Previously Attended (excluding Pierce College) If you

met the language requirement in High School – a High School transcript is also required. All

transcripts need to be mailed directly to you – NOT the college itself (either hard copy or

electronically) & NOT the nursing office. Please include the sealed transcript(s) in your packet.

□

Proof of Spring and/or Summer Quarter classes 2014 Registration (if applicable)

 “Proof” entails a receipt from the registration office of the college you are currently attending (Spring) or plan to attend (Summer). This receipt will show the course number and title for which you are registered and proof that you have paid. ANOTHER OFFICIALTRANSCRIPT showing successful completion will be required.

□

Proof of 1

st

_{Hepatitis B Injection (in a series of 3 – as it takes 6 months to complete the series)}

 Must have documentation from medical facility administering injection.

□

Professional Recommendation (form included in packet) Delivered to you and included in packet.

□

Personal Recommendation (form included in packet) Delivered to you and included in packet.

□

Functional Resume (as close to 1 page as possible)

□

Personal Statement (directions included in packet)

Please follow directions carefully

.

**

________Research Paper

Content not to exceed 2 double spaced pages

.

**

________Kaplan Entrance Exam (New Requirement) If you have taken this exam at Pierce College,

we will retrieve your scores through our Nursing Kaplan Account. If you have taken the exam at another

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institution, you will need to request an official transcript of your Kaplan test result and include it in this

packet.

**

________For LPN to RN/BRIDGE Application cycle only………

Copy of UNENCUMBERED LPN License or Certificate of Completion or Proof of registration in

final quarters of practical nurse training.

□

All Necessary Waivers-Already completed and on file with Nursing Advisor (if applicable)



Please submit every element (except application payment itself and the Admissions form to Pierce

College) in your packet - directly to the Nursing Department.



Deadlines and requirements will be strictly adhered to. Failure to submit the proper paperwork and

all required elements on time to the Nursing Program Office will result in a non-qualifying

application and will be dismissed from consideration. Due Date Postmarks will be accepted on your

packet if you are mailing it in.

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PIERCE COLLEGE ASSOCIATE DEGREE IN NURSING - PROGRAM APPLICATION

Application Due: July 7, 2014 or Before

Pierce College

Student ID #

*Social Security #

Name

Last First Middle

Previous Names

DOB:

mm/dd/yy

Mailing Address

Street Address Apt #

City State Zip Code

Primary Phone

Cell Phone

Email Address

Emergency

Contact

Relationship

Primary Phone

Cell Phone

Declaration of Ability to Meet Essential Qualifications:

It is essential that nursing students be able to perform a number of physical activities during the clinical portion of the program. These will include, but are not limited to the following: effective communication, lifting/transferring patients, observation/assessment of clients using the physical senses, standing for long periods, performing bending activities, and executing movements required to care for patients in all health care settings. The clinical experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties that impact patients’ lives. Students must be able to demonstrate rational and appropriate judgment and behavior under stressful conditions. Individuals should carefully consider the mental and physical demands of the program prior to making application.

I certify the following to be true:

 I have provided true, correct and complete information with this application. I have read and understand the information included in this application packet.

 I have read and understand the Declaration of Ability to Meet Essential Qualifications and certify that I will be able to perform the essential functions as a nursing student in the Pierce College Puyallup Associate Degree in Nursing Program.

Applicant Signature Date

_______________________________________________________________ Applicant Name (please print)

*Your social security number is confidential and, under a federal law called the Family Education Rights Privacy Act, the college will protect it from unauthorized use and/or disclosure. In compliance with state/federal requirements, disclosure may be authorized for the purposes of state and federal financial aid, Hope/Lifetime Learning tax credits, academic transcripts, assessment or accountability research.

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COURSE PREREQUISITE LISTING FORM

Application Due: July7, 2014 or Before

Name:

SID:

Please fill out this sheet completely. Applicant’s Spring and Summer course registration information must accompany this form (if prerequisites remain to be taken). If any of the following prerequisites were taken at an accredited Washington State college, their equivalencies can be found on the Course Equivalency Chart. It is the responsibility of the applicant to provide proof of equivalency if courses were taken at an institution that is not listed on the equivalency form. Equivalency must be reviewed and approved by the Nursing Program Director or Coordinator prior to application deadline. When seeking a waiver for coursework taken at a non-Washington college, a course description, syllabus, or course outline must be submitted.

All official transcripts (excluding Pierce College) must be sent to Pierce College Nursing Office. It is the responsibility of the applicant to ensure that these documents are received prior to the application deadline. Transcripts may be hand carried by the applicant as long as they are in their original sealed envelopes.

College

Course

College name you attended or plan to attend QTR/Year taken or plan to take (i.e. Fall 2003) Course # you took or plan to take (i.e. CHEM 121)

Course name you took or plan to take (i.e. Inorganic Chemistry)

Number of credits earned Specify Credit type: (quarter or semester)

- Official use Only-

Course Last Grade Equivalent “7”Years Received ? ? ? English Composition (ENGL&101) Anatomy Physiology I (BIOL& 241) Anatomy Physiology II (BIOL& 242) Microbiology (BIOL& 260) Inorganic Chemistry (CHEM& 121) Organic Chemistry (CHEM& 131) Dev. Psych (PSYCH& 200) Statistics. (MATH& 146) Foreign Language

(or high school Equivalent)

List all Colleges Attended:

Rcv’d? Date: Copy to TO?

Do you have a prior degree? _ASSOC. BA/BS_What Year?____ .

I have completed the Kaplan Entrance Exam: Date Institution .

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PROFESSIONAL RECOMMENDATION/REFERENCE FORM

Pierce College Associate Degree in Nursing Program

Due By: July 7, 2014 or Before

PLEASE PRINT:

I, ___________________________________, Nursing Program applicant, give my permission to

(Applicant’s Name)

___________________________________, to complete this reference form and return it to me in a sealed envelope with

her/his name written across the back seal.

(Recommending person’s name)

Nursing Program Office.

---

TO THE PERSON MAKING THE RECOMMENDATION:

Please respond to the following questions carefully in the space provided. If you need additional space, please respond to

each question separately on ONE sheet of paper. Generic letters of recommendation will not be accepted. The Nursing

Program carefully considers all recommendations for nursing applicants, and as much insight, detail and clarity in

answering the following questions will be of great benefit to the applicant. Thank you very much.

► Describe the professional traits that this applicant possesses that you would look for in a nurse taking care of you or one of your family members.

____________________________________________________________________________________________________________

__________________________________________________________________________________________

► Describe the applicant’s work ethic and competence. You may comment on his/her perseverance, dependability, initiative, teamwork, punctuality and his/her dedication and commitment to quality performance, workmanship or product.

__________________________________________________________________________________________

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► Speak to the applicant’s leadership ability, character, and well-roundedness.

__________________________________________________________________________________________

Please complete the following:

I have known the applicant for _________________ years and _________________ months. (Approximations OK) During this time

the applicant was a ____________________________________ (student, employee, co-worker, etc.) of mine

at ____________________________________________________ (name of school, business or other organization).

Please Print

Your Name _______________________________________________________________

Title _______________________________________________________________

Company or Organization _______________________________________________________________

Phone _______________________________________________________________

Alternate Phone (if applicable) _______________________________________________________________

E-mail _______________________________________________________________

Signature _______________________________________________________________________ Date _______________________

NOTE:

Please mail – or deliver - the completed form BACK to the Applicant. Please seal the envelope and write your name across the seal. The Applicant will need to include your recommendation in their Application Packet – which then needs to arrive in our office no later than Monday, July 7, 2014.

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PERSONAL RECOMMENDATION/REFERENCE FORM

Pierce College Associate Degree in Nursing Program

Due By: July 7, 2014 or Before

PLEASE PRINT:

I, ___________________________________, Nursing Program applicant, give my permission to

(Applicant’s Name)

___________________________________, to complete this reference form and return it to me in a sealed envelope with

her/his name written across the back seal.

(Recommending person’s name)

Nursing Program Office.

---

TO THE PERSON MAKING THE RECOMMENDATION:

Please respond to the following questions carefully in the space provided. If you need additional space, please respond to

each question separately on ONE sheet of paper. Generic letters of recommendation will not be accepted. The Nursing

Program carefully considers all recommendations for nursing applicants, and as much insight, detail and clarity in

answering the following questions will be of great benefit to the applicant. Thank you very much.

► Describe the personal and ethical traits that this applicant possesses that you would look for in a nurse taking care of you or one of your family members.

____________________________________________________________________________________________________________

__________________________________________________________________________________________

► Describe the applicant’s potential for service to his/her community.

__________________________________________________________________________________________

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► Nursing school can be challenging and stressful, yet rewarding. Describe the applicant’s potential to succeed as an adult learner. Please comment on the applicant’s support system and his/her ability to adapt to change.

__________________________________________________________________________________________

Please complete the following:

I have known the applicant for _________________ years and _________________ months. (Approximations OK) During this time

the applicant was a ____________________________________ (student, employee, co-worker, etc.) of mine

at ____________________________________________________ (name of school, business or other organization).

Please Print

Your Name _______________________________________________________________

Title _______________________________________________________________

Company or Organization _______________________________________________________________

Phone _______________________________________________________________

Alternate Phone (if applicable) _______________________________________________________________

E-mail _______________________________________________________________

Signature _______________________________________________________________________ Date _______________________

NOTE:

Please mail - or deliver- the completed form BACK to the Applicant. Please seal the envelope and write your name across the seal. The Applicant will need to include your recommendation in their Application Packet – which then needs to arrive in our office no later than Monday, July7, 2014.

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PERSONAL STATEMENT - RESEARCH QUESTION – KAPLAN EXAM

Application Due By: July 7, 2014 or Before

Instructions:



In your personal statement, please respond to all questions.



Please answer each question separately. Applicants are allowed one page for Question 1A, one

page for Question 1B, and two pages for Question 2.



The personal statement must be written in 11-12 point font size, double-spaced, and Times New

Roman font style on an 8½ x 11 standard sheet of paper.



At the bottom of EACH page print and sign your name.

The Personal Statement MUST specifically address the following:

1. Since nursing continues to be the #1 high-demand health occupation, it is critical that applicants to

nursing programs make an “informed” decision and know this is what they really want to do. This

question is the opportunity to describe not only the intrinsic motivators but also extrinsic motivators

that you have pursued to help you develop realistic expectations of this profession. Intrinsic

motivators could include: personal desire, skills, strengths, attributes, self knowledge and personal

growth gained through life’s challenges and significant emotional events, etc. Extrinsic motivators

could include: work or volunteer experiences in a nursing care environment, job shadowing,

informational interviews with RN’s (currently working), or nursing research about scope of practice

and changing trends in nursing practice).

Question 1A:

Describe the factors that influenced your decision to choose nursing as a career. Be sure to include

intrinsic motivators as well as extrinsic motivators. (1 page maximum)

Question 1B:

Illustrate how you are a good fit for our program and, in turn, how our program would be a good

fit for you. (1 page maximum)

2. With the changing demographics in our region, the nursing profession is faced with an increasingly

diverse patient clientele. Nursing requires an understanding of underrepresented cultural, racial and

social groups along with awareness of economic issues related to healthcare. As a result, there is a

growing need for nursing professionals who are sensitive to language barriers and human differences.

Question 2:

Describe your experiences working and interacting with diverse groups of individuals. Share the

lessons you feel you’ve learned from these experiences. (2 pages maximum)

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The Research Question: Using three current peer reviewed references (5 years old or newer), describe the

three functions of the kidney. Support your writing through use of in-text citations and a reference list. Use

12 point font size, New Times Roman font style, double space and limit the paper to 4 total pages to include a

title page, content(2 pages) and reference list. (May be either APA or MLA)

The Kaplan Entrance Exam will be offered at the Puyallup Campus testing center five (5) days a week

from 8:00am to 1:00pm – starting Jan 2, 2014. Please call the Testing Center at 253-840-8341

or 253-840-8343 for an appointment. The cost will be $25.00 – payable at the Cashiers Office.

There will NOT be a minimum required score. We will be retrieving your score through our Nursing

Kaplan account and it will be added to the other required elements in your application to our program.

The test must be taken within 1 year of the application date and only one (1) repeat is allowed.

If you take the test at another institution, you will need to request an official transcript of your Kaplan

test results and include it in your application packet.

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APPLICATION INTERVIEWS

INTERVIEW INVITATIONS CONTAINING DETAILS WILL BE SENT TO THOSE WITH THE HIGHEST OVERALL SCORES. SUCCESSFULLY PASSING A CRIMINAL BACKGROUND CHECK WILL BE REQUIRED BEFORE MOVING ON TO THE PHASE III INTERVIEWS. AS WELL AS A STATEMENT SIGNED BY YOU VERIFYING THAT YOU ARE ELIGIBLE FOR REHIRE AT YOUR PREVIOUS PLACES OF EMPLOYMENT AND WILL WORK NO MORE THAN 20 HRS A WEEK.

POST-ACCEPTANCE REQUIREMENTS

Admitted students and alternates will receive nursing program orientation paperwork upon final class selection.

Please keep the following in mind during the application process:

Proof of

Immunizations/Titers:



Completed Hepatitis B series (3 injections in all) and Positive Hep B titer result



Tdap (in last ten years)



2-step TB screening (annually) or chest x-ray ( if history of positive TB skin test).



Positive Varicella (Chicken Pox) titer or (2) injections



Measles/Mumps/Rubella (2 injections or positive titer) for all 3 diseases



Flu Vaccine (Proof of vaccination for current season)



Immunization requirements may change based on CDC guidelines and/or clinical facility policies.



Prior to the Phase III Interviews the student must receive a “No Record on File” report related to Crimes Against

Persons from Certified Background Check (facilitated by nursing dept). (Refer to more information and links to

disqualifying factors on our website.)



Documentation of current American Heart Association CPR for Healthcare Provider Training (Must include

Infant and child CPR).



First Aid training course.



Copy of Certification for 7-hour AIDS Training Course.



HIPAA training (facilitated by nursing dept). Fire safety and blood born pathogens – modules on line.



Drug testing (facilitated by nursing dept).



LPN License required for LPN/RN Bridge applicants only (During March Application Period)



Proof of Personal Health Insurance Coverage.



Any additional requirements will be included in the application packet.

***The occupation of RN requires physical strength and stamina. The student may be expected to lift up to 60lbs and

stand for long periods of time.

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SECTION FOUR

Appendix



Prerequisite Course Equivalency Chart



Estimated Program Costs



Financial Aid, Scholarships and Loans



Frequently Asked Questions



Washington State Nursing Programs

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PREREQUISITE COURSE EQUIVALENCY CHART

Applicant please note:

This course equivalency chart has been provided for your convenience, as a planning tool only. Please NOTE it is

the applicant’s responsibility to verify any transfer courses to match the Pierce College requirements prior to

application.

It is the applicant’s responsibility to verify course equivalencies. Pierce College is not responsible for changes

to the information below

.

Community

College

Courses

Inorganic Chemistry

Microbiology Anatomy & Physiology I Anatomy & Physiology II English Composition Statistics (Transfer-Ready Requirement) Lifespan Development (Transfer-Ready Requirement) Organic Chemistry (recommended)

Bellevue 101 BIO 250 BIO 260 BIO 261 101 171 204 102

Big Bend 101 215 BIO 210 BIO 211 101 103 OR 161 210 102 Cascadia 120 BIOL 215 BIO 210 BIO211 101 135 206 220

Centralia 101 BIO 211 ZOO 251 ZOO 252/253

101 108 240 102

Clark 111 BOI 240 BIO 231 BIO232 BIO 233 101 203 211 112 CLOVER PARK TECH --- --- --- --- 101 MAT 200 --- Columbia Basin 110/110.1 BIO 260/260.1 BIO 221/221.1 BIO 222/222.1 101 143 240 120/120.1

Edmonds 101 BIO 250/L BIO 230 BIO 231 100 240 --- 102

Everett 101 BIO 250 BIO235 BIO 237 101 281 203 102

Grays Harbor 101 BIO 211 BIO 208 BIO 209 101 260 220 102

Green River 101 BIO 210 A&P 205 A&P 206 110 256 210 102

Highline 121 BIO 250 BIO 231 BIO 2323 WRIT 101 210 215 122 Lake Washington 101 215 211 212 101 120 105 102 Lower Columbia 111 BIO 257 BIO 221 OR ZOO 121 BIO 222 OR ZOO 122 101 210 205 112

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Community

College

Courses

Microbiology Anatomy & Physiology I Anatomy & Physiology II English Composition Statistics (Transfer-Ready Requirement) Lifespan Development (Transfer-Ready Requirement) Organic Chemistry (recommended) N.W. Indian College

111 BIO 245 BIO 242 BIO 243 101 107 201 112

Olympic 121/121L BIO 260 BIO 250 BIO 251 101 281 224 122/122L

Peninsula 101L BIO 240L BIO 201/L BIO 202/L 111 281 225 102L

PIERCE COLLEGE

121 MICRO 260 BIO 241 BIO 242 101 146 200 131

Renton Technical College CHEM 140 BIO 210 BIO 220 BIO 221 101 210 PSY 210 -- or BIOL 140 Seattle Central

CHE 101 BIO 280 A&P 213 A&P 214 101 109 206 CHE 102

Shoreline 101 BIO SCI 215 210 211 101 MATH 108 204 220

Skagit Valley 131 BISC 215 BISC 242 BISC 243 101 108 110 132

S. Puget Sound

101 BIO 211 BIO 205 BIO 206 WRIT 101 108 220 102

South Seattle

CHE 101 BIO 280 ANP 213 ANP 214 101 240 206 CHE 102

Spokane or Spokane Falls

101 OR 161

MBIOL 231 A&P 242 A&P 243 101 221 201 162

Tacoma C.C. 101 BIO 201 BIO 220 BIO221 101 108 206 102 or BIO 240/ 241/ 242

Walla Walla 107 BIO 230 BIO 210 BIO 211 101 201 103 108 + 109

Wenatchee Valley

110 BIO 223 BIO 221 BIO 222 101 201 201 111

Whatcom 115 BIO 240 BIO 270 BIO 271 101 240 216 251

Yakima

109/110 BIO 232 BIO 230 BIO 231 101 BA 256 Business

Stats

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University

Courses

Microbiology Anatomy & Physiology I Anatomy & Physiology II English Composition Statistics (Transfer-Ready Requirement) Lifespan Development (Transfer-Ready Requirement) Organic Chemistry (recommended) Central WA University

111/111L BIOL 322 BIOL 355 BIOL 356 101 (4cr) 311 313 (4 cr) 112/112L

Eastern WA University

161 BIO 335 BIO 232/ 233/ 234 101 NURS 318 380 162

Gonzaga 101 & 101/L BIOL 170/170L EXSC 241/241L EXSC 242/242L 101 NURS 320 NURS 492 220 Northwest SCIE 1204/1201

SCIE2104 SCIE 2203/1 SCIE 2203/1 1013 2003 PSYC 2563 SCIE 1213/1211 Pacific Lutheran U.

104 BIO 201 BIO 205 BIO 206 101 STATS 231 320 105??

Seattle Pacific U.

CHM 1211

BIO 3351 BIO 2129 BIO 2130 1101 HSC 4044 or M 1360

2470 CHM 1330

Seattle U.

101 BIO 220 BIO 200 BIO 210 110 NURS 202 or 244

322 102

St. Martin’s

141 BIO 351 BIO 328 BIO 329 101 201 205 & 305 201/201L

Univ. of Puget Sound

110 BIO 350 BIO 221 BIO 222 101 271 273 & 274 250

Univ. of WA 120 MICRO 301 BIOL 118/119 BSTR 301 111, 121 or 131 QMETH 201 or STAT 220 NURS 201 220 Walla Walla College

101 BIO 222 BIO 201 BIO 202 121 &122 206 215 & 216 102/103

WA State University

101 MBIOS 101 BIOL 251 BIOL 315 101 STAT 212 HD 101 102

Western WA University

115 BIO 345/346 BIO 348 BIO 349 101 240 230 251

Whitman 125/135 339 111 120 110 107 110 126 Whitworth CH 101/101L or CH 161/161L BI 204 BI 220 BI 221 110 256 PY 210W CH 163/163L

Most Washington community colleges are participating in the Common Course Numbering System as of January 1, 2009. This chart is to be used for courses taken Summer, 2008 or after at any of the schools listed below. For courses taken at a State of Washington school not listed below, you must refer to the above chart and cross-reference it with the chart below.

Bates, Bellevue, Bellingham, Big Bend, Cascadia, Centralia, Clark, Clover Park, Everett, Grays Harbor, Lake Washington, Olympic, Peninsula, Pierce, Renton, Seattle Central, Seattle North, Seattle South, Shoreline, Skagit, South Puget Sound, Spokane, Spokane Falls, Tacoma, Wenatchee, Whatcom, Yakima.

Intro to Chemistry Micro-biology Human A&P I Human A&P II English Composition Intro To Statistics (Transfer-Ready Requirement) Lifespan Develop-ment (Transfer-Ready Requirement) Intro to Organic/ Biochemistry (recommended)

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APPENDIX

Estimated Program Cost

Financial Aid, Scholarships and Loans

Frequently Asked Questions

Washington State Nursing Programs

Pierce College Associate Degree in Nursing Estimated Program Costs

The following information is based on the current Pierce College Winter tuition table and Amazon.com list prices for new textbooks. The information provided is subject to change without notice and does not include sales tax.

Initial Pre-Program Costs (estimated)

Application Fee $65.00 (Bridge $50.00) HIV/AIDS Training, CPR/First Aid Certification Cost varies Immunizations, Titers and Health Assessment - Health Insurance Cost varies Pierce College Nursing Student Uniform (2 sets) . $80-100.00 Clinical Supplies (lab coat, shoes, socks, long sleeve shirt, stethoscope, watch, etc.) $200.00

Kaplan Entrance Exam 25.00

Estimated Current Costs for Tuition (Tuition calculated for Washington state residents.)

This estimate does not reflect the upcoming tuition increase.

Quarter I

$1332.62

Quarter II

$1275.38

Quarter III

$1275.38

Quarter IV

$1332.62 (Bridge Students $1561.58)

Quarter V

$1389.86

Quarter VI

$1275.38

Total Estimated Tuition Cost

$7,881.24

(Bridge Students $4226.82 Plus additional

Listed expenses)

Estimated Cost for Books

$300 - $500 per Quarter*

Testing fee for each quarter: $83.50

Lab fee for each quarter: $75.00

*(Recommended/Optional Book List is also available)

NCLEX-RN Exam and State Fees $288.00

(Additional fees and supplies may occur and the cost would vary)

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FINANCIAL AID, SCHOLARSHIPS AND LOANS

Financial Aid may be available to assist you. Deadlines are strictly adhered to, so students are encouraged to apply early.

Pierce College Puyallup Financial Aid

1601 39

th

_{Avenue S.E.}

Puyallup, WA 98374

(253) 840-8398

Federal School Code: 005000

http://www.pierce.ctc.edu/financialaid/

Grants & Loans

All award ranges listed here are valid for the current academic year and are only listed as a general indication.

Federal Pell Grants

Federal Pell grants are awarded only to undergraduate students who have not earned a bachelor’s degree.

To determine if you are eligible, the U.S. Department of Education uses a standard formula to evaluate the information you report on your Free Application for Federal Student Aid (FAFSA). This formula produces an Expected Family Contribution (EFC) number that appears in the upper right portion of page one on your Student Aid Report (SAR). This number will determine if you are eligible for a Pell Grant.

Pell grants range from $400 to $4300. The amount of your award will depend on your Expected Family Contribution, your enrollment status (part or full time), and whether you attend college for a full academic year. You may not receive Pell Grant funds from more than one school at a time.

Your Pell Grant will be used to pay your tuition and fees with any remaining funds paid to you after the academic quarter begins.

Federal Supplemental Education Opportunity Grants (FSEOG)

An FSEOG is for undergraduate students with exceptional financial need as shown by having the lowest Expected Family

Contributions. FSEOG awards at Pierce College range from $100 to $600 per academic year. You will receive your FSEOG funds in a check after the academic quarter begins.

State Need Grant

The State Need Grant helps low income undergraduate students pursue degrees. To be eligible, a student’s family income cannot exceed 65 percent of the state’s median family income. The grant amount at Pierce College ranges from $1,877-2300 per year. Students who have already earned an AA or BA are not eligible for this grant. State Need Grant recipients must be enrolled for a minimum of six credits each quarter.

Day Care Grant

These funds are used to assist students with child care expenses. State of Washington resident status is required.

Pierce College Grant

These funds are used to assist students with tuition, fees, books and living expenses. State of Washington resident status is required.

Tuition Waiver

This program pays resident tuition for students who are residents of the State of Washington and meet certain eligibility criteria. Tuition waivers do not include fees and no refunds will be issued to students.

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Federal Perkins Loans

A Federal Perkins loan is a low interest (currently 5%) loan for both undergraduate and graduate students with financial need made with funds from the federal government and Pierce College. Pierce College is your lender, and you must repay this loan to the college. Depending on when you apply, your level of need and the availability of funds, Pierce College may lend you up to $3000 for an academic year. You will paid by check after the beginning of the academic quarter.

Repayment of your loan will begin after you cease attending Pierce College at least half time (six credits or more). You will have a nine month grace period before your first payment becomes due.

Each student borrower is provided with specific information on any deferment and cancellation provisions that apply to the loan when you borrow and during your exit interview when you leave school.

Stafford Loans

These loans require that you complete a Free Application for Federal Student Aid (FAFSA).

The funds are loaned by banks to the student. Loans are repaid after you graduate, leave school or drop below half-time enrollment (six credits); you will have a six month grace period before you begin repayment.

If you have financial need remaining after you have been awarded grant, work and scholarship funds, you can borrow Stafford Loan funds. This type of loan is subsidized, which means that the government pays the interest while you are in school, during the grace period and when you qualify for deferments.

If you do not have demonstrated financial need, you may be eligible to receive an unsubsidized loan. Unlike the subsidized loan, you are responsible for the interest from the time the unsubsidized loan is disbursed until it is paid in full. You can choose to pay interest or allow it to accumulate and be capitalized (that is, added to the principal amount of your loan).

Loan funds are sent to the school for you on a quarterly basis by the lender. Students receiving their first loan for their first term of college attendance cannot be paid the funds until 30 days after the quarter begins.

Dependent undergraduate students are limited to loans up to $3500 (first year students) or up to $4000 (students with more than 45 credits completed).

Independent undergraduate students may be able to borrow up to $7000 as a first year student and $8000 if they have completed over 45 credits. However, at least $4000 of this amount will be in the form of unsubsidized loans.

The interest rate on both of these loans is a variable rate that changes on an annual basis. However, the interest rate will never exceed 8.25 percent.

PLUS Loans (Parent Loans)

PLUS loans allow parents who have an acceptable credit history to borrow funds to pay the educational expenses of a child who is a dependent student enrolled at least half-time. The yearly limit on a PLUS Loan is equal to your cost of attendance minus any other financial aid you receive from Pierce College or other organizations. Contact the Financial Aid Office

(http://www.pierce.ctc.edu/financialaid/contact.php3) for more information.

Scholarship Opportunities

The Pierce College Foundation administers private scholarships for Pierce College students. These scholarships are awarded based on need, academic ability, artisitic talent, vocational goals, and/or other factors. Information on newly funded scholarships will be posted in the Financial Aid office.

For more information about any of the scholarships, contact Ruth Ann Hatchett, District Scholarship Program Administrator, at (253)864–3261 or rhatchett@pierce.ctc.edu.

The Pierce College Foundation acquires private funding for the college, provides enhancements to college programs, improves access for students, and promotes the college to the community. For more information about the Pierce College Foundation, visit the Foundation Web site (http://www.pierce.ctc.edu/foundation/)